【摘要】 即使不合并心房颤动或心房扑动，心力衰竭(HF)患者发生脑卒中及其他血栓栓塞事件的风险也会增加。目前指南推荐合并心房颤动的HF患者使用口服抗凝药物，然而预防性抗凝是否能使窦性心律HF患者获益尚不清楚。较早的随机试验指出华法林可降低此类患者缺血性脑卒中的发生率，该益处被高出血风险所抵消。然而这些试验包括了所有窦性心律HF患者，仍存在高脑卒中风险的患者亚群可能从抗凝治疗中获得临床净收益。现通过回顾和总结目前对窦性心律HF患者进行脑卒中风险分层的工具和方法，来识别可能从抗凝治疗中获益的患者亚群，权衡脑卒中和出血风险，考虑是否向患者推荐使用抗凝药物。更多还原

【Abstract】 Patients with heart failure experience an increased risk of thromboembolic events including stroke, even without atrial fibrillation or atrial flutter.Current guidelines recommend oral anticoagulants for patients when atrial fibrillation is present, however, the benefits of this therapy in patients with heart failure and sinus rhythm are unclear.Early randomized trials showed that warfarin reduced the incidence of ischemic stroke in patients with heart failure and sinus rhythm, but the benefits were offset by the higher blood risk.However, these trials included all patients with heart failure in sinus rhythm, and a subset of patients who remain at high risk for stroke may receive a net clinical benefit from anticoagulation.The purpose of this paper is to identify subgroups of patients who may benefit from anticoagulation by reviewing and summarizing current tools and methods for risk stratification of stroke in patients with heart failure and sinus rhythm.Clinical doctors may consider whether or not to recommend anticoagulation for these patients after weighing the risk of stroke and bleeding.更多还原